State health officials yesterday reported that nearly one in three inmates entering Maryland's prison system is infected with HIV, syphilis, or hepatitis B or C virus -- many of them with more than one infection.

Infection rates among prisoners were dramatically higher than among the general population, based on blood tests of 3,914 people entering the state penal system during a 60-day period in 2002. Hepatitis C was the most prevalent infection in Maryland state prisons, according to the Maryland AIDS Administration's report.

Liza Solomon, the agency's director, said less than 2 percent of the U.S. population is infected with hepatitis C, but 29.7 percent of the Maryland prisoners were infected. The higher rate of disease among prisoners has major public health implications beyond prison walls, she said, because inmates eventually are released into the community, where they can spread the infections. Reaching undiagnosed inmates is an important opportunity for the state to limit diseases that can disrupt or prematurely end lives. Solomon said the study is the first to show systematically that prisoners often have several of the infections simultaneously. Such co-infections are harder to manage, and the symptoms are more severe, she said.

Inmates in Maryland are treated for syphilis and HIV, but the prisons do not routinely give hepatitis B vaccinations, which are highly effective, to inmates or staff members, Solomon said. The prisons offer no routine treatment for inmates with hepatitis C, for which there is no vaccine, she said. The District Health Department's Chief Medical Officer Michael S.A. Richardson said that diagnosing hepatitis C may not be worthwhile because it is not clear that the expensive treatments are effective. "Diagnosing stuff you aren't going to treat is always questionable," Richardson said.

The study also concluded that women entering the Maryland prison system are far more likely than men to be infected with HIV, syphilis and hepatitis C, though not hepatitis B.

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